Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
Clinical Research Institute, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
Eur J Cardiothorac Surg. 2018 Feb 1;53(2):372-378. doi: 10.1093/ejcts/ezx295.
Radiologically small-sized adenocarcinomas are special entities of lung cancer, as their radiological and pathological invasiveness determines the surgical procedures applied; however, the clinicopathological features of small-sized lung adenocarcinoma adjoining cystic airspaces (Ca-ADJ) have yet to be fully clarified. The aim of this study was to elucidate the clinicopathological characteristics, including the programmed death ligand 1 (PD-L1) expression, in patients with Ca-ADJ ≤3.0 cm.
A total of 283 patients with resected adenocarcinoma, whose radiological tumour size was ≤3.0 cm without lymph node or distant metastases on preoperative high-resolution computed tomography, were analysed for their clinicopathological and radiological features. Furthermore, the PD-L1 expression was evaluated by immunohistochemistry using an anti-human PD-L1 rabbit monoclonal antibody (clone SP142).
Among the 283 patients, 31 (11.0%) patients were reported to have Ca-ADJ. The Fisher's exact test demonstrated that Ca-ADJ was significantly associated with male gender (P < 0.001), a history of smoking (P < 0.001), a high consolidation/tumour ratio (P = 0.026), advanced pathological stage (P < 0.001), the presence of pleural (P < 0.001) and vessel invasion (P < 0.001), histological invasive subtypes (P < 0.001) and wild-type epidermal growth factor receptor (P = 0.001). The patients with Ca-ADJ had a significantly higher maximum standardized uptake value than those without Ca-ADJ (8.4 vs 4.1, P < 0.001). Furthermore, Ca-ADJ was significantly associated with the PD-L1 expression (P < 0.001). Log-rank test showed that patients with Ca-ADJ had a significantly shorter disease-free survival than those without Ca-ADJ (P = 0.001).
This study showed that patients with radiologically small-sized Ca-ADJ might exhibit radiologically and pathologically invasive features.
影像学小尺寸腺癌是肺癌的特殊实体，因为其影像学和病理学侵袭性决定了所应用的手术程序；然而，毗邻囊状气腔的小尺寸肺腺癌（Ca-ADJ）的临床病理特征尚未完全阐明。本研究旨在阐明包括程序性死亡配体 1（PD-L1）表达在内的 Ca-ADJ≤3.0cm 患者的临床病理特征。
对 283 例术前高分辨率 CT 显示无淋巴结或远处转移、影像学肿瘤大小≤3.0cm 的腺癌患者进行了临床病理和影像学特征分析。此外，使用抗人 PD-L1 兔单克隆抗体（克隆 SP142）通过免疫组织化学评估 PD-L1 表达。
在 283 例患者中，有 31 例（11.0%）报告有 Ca-ADJ。Fisher 确切检验表明，Ca-ADJ 与男性（P<0.001）、吸烟史（P<0.001）、高实变/肿瘤比（P=0.026）、较高的病理分期（P<0.001）、胸膜（P<0.001）和血管侵犯（P<0.001）、组织学侵袭亚型（P<0.001）和野生型表皮生长因子受体（P=0.001）显著相关。有 Ca-ADJ 的患者最大标准化摄取值明显高于无 Ca-ADJ 的患者（8.4 比 4.1，P<0.001）。此外，Ca-ADJ 与 PD-L1 表达显著相关（P<0.001）。对数秩检验显示，有 Ca-ADJ 的患者无病生存期明显短于无 Ca-ADJ 的患者（P=0.001）。
本研究表明，影像学小尺寸 Ca-ADJ 患者可能表现出影像学和病理学侵袭性特征。
